Provider Demographics
NPI:1649672767
Name:ELIAS S RODRIGUEZ MD
Entity type:Organization
Organization Name:ELIAS S RODRIGUEZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-722-4016
Mailing Address - Street 1:10 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4202
Mailing Address - Country:US
Mailing Address - Phone:831-722-4016
Mailing Address - Fax:831-722-7756
Practice Address - Street 1:622 E ALISAL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2668
Practice Address - Country:US
Practice Address - Phone:831-757-6191
Practice Address - Fax:831-757-0251
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIO DEL MAR MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19447ZOtherMEDICARE GROUP